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June 16, 1993, Vol 269, No. 23 >
ARTICLE | June 16, 1993

The Completeness of AIDS Case Reporting in New York City FREE

Alan E. Greenberg, MD; Rita Hindin, PhD; Antonina G. Nicholas; Eula L. Bryan; Pauline A. Thomas, MD
[+] Author Affiliations

Reprint requests to the Office of AIDS Surveillance, New York City Department of Health, Box 44,125 Worth St, New York, NY 10013 (Dr Greenberg).


JAMA. 1993;269(23):2995-3001. doi:10.1001/jama.1993.03500230077033
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References

Objective.  —To assess the completeness of acquired immunodeficiency syndrome (AIDS) case reporting in New York City (NYC), and to determine whether the completeness of reporting differs in various populations.

Design.  —Retrospective record review of hospital laboratory logs, death certificates, hospital discharge records, and patient registries at private physicians' offices and hospital outpatient clinics.

Setting.  —Public and private hospitals, and private physicians' offices in NYC.

Patients.  —Adults and adolescents with AIDS or with illnesses suggestive of AIDS were identified using both population-based and nonrandom sampling techniques. These persons were matched with the NYC AIDS case registry, and the medical records of nonmatching persons were reviewed to determine whether they met the 1987 Centers for Disease Control and Prevention surveillance case definition for AIDS.

Main Outcome Measures.  —The completeness of reporting was calculated for the five individual projects and for the aggregate database by gender, race/ethnicity, risk, borough of residence, age, first AIDS diagnosis, and year of diagnosis.

Results.  —Of 7015 persons with AIDS identified in the five projects, 5912 (84%) had been previously reported (range, 77% to 89%). The completeness of reporting ranged from 81% to 87% in all major gender, race/ethnicity, risk, borough of residence, and age subgroups. In a multivariate analysis, the odds of being unreported were significantly higher among outpatients in hospital clinics, out-of-state residents, persons with diagnoses other than Pneumocystis carinii pneumonia, and persons recently diagnosed with AIDS.

Conclusions.  —This study indicates that the NYC AIDS surveillance system functioned effectively during the first decade of the AIDS epidemic. Completeness-of-reporting studies are an integral part of AIDS surveillance, providing data that are critical for assessing the validity of the AIDS surveillance database.(JAMA. 1993;269:2995-3001)

REFERENCES

1 +
AIDS Surveillance Update . New York, NY: New York City Dept of Health Office of AIDS Surveillance; July 1992;.
2 +
HIV/AIDS Surveillance . Atlanta, Ga: Centers for Disease Control; April 1992;.
3 +
United States Congress. S 2240, The Ryan White Comprehensive AIDS Resources Emergency Act of 1990. Congressional Record, House. July 31,1990; H6024-H6048.
4 +
Thomas PA, Weisfuse IB, Greenberg AE, et al.  Trends in the first ten years of AIDS in New York City. Am J Epidemiol . 1993;;137:121-133.
5 +
Greenberg AE, Evans R, Bryan E, Lopez E, Thomas P, and the NYC Expanded Outpatient Surveillance Project. Completeness of AIDS case reporting and the spectrum of HIV-related disease among outpatients in New York City. In: Program and abstracts of the Sixth International Conference on AIDS; June 19-24, 1990; San Francisco, Calif. Abstract ThC708.
6 +
Hindin RH, Thomas P, Nicholas A, Miller N, Schultz S. Evaluating completeness of New York City's case registry. In: Program and abstracts of the Fifth International Conference on AIDS; June 4-9, 1989; Montreal, Quebec. Abstract TAP70.
7 +
Mokotoff ED, Galbraith MA.  Underreporting of AIDS in South Carolina. JAMA . 1990;;263:2449-2450.
8 +
Hardy AM, Starcher ET, Morgan WM, et al.  Review of death certificates to assess completeness of AIDS case reporting. Public Health Rep . 1987;; 102:386-391.
9 +
Buehler JW, Berkelman RL, Stehr-Green JK.  The completeness of AIDS surveillance. J Acquir Immune Defic Syndr . 1992;;5:257-264.
10 +
Conway GA, Coulley-Niemeyer B, Pursley C, et al.  Underreporting of AIDS cases in South Carolina, 1986-1987. JAMA . 1989;;262:2859-2863.
11 +
Rosenblum L, Buehler JW, Morgan MW, et al.  The completeness of AIDS case reporting, 1988: a multisite collaborative surveillance project. Am J Public Health . 1992;;82:1495-1499.
12 +
Calzara LM, Coates RA, Craib KJP, et al.  Underreporting of AIDS cases in Canada: a record linkage study. Can Med Assoc J . 1990;;142:36-39.
13 +
Chamberland ME, Allen JR, Monroe JM, et al.  Acquired immunodeficiency syndrome in New York City: evaluation of an active surveillance system. JAMA . 1985;;254:383-387.
14 +
Centers for Disease Control.  Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR Morb Mortal Wkly rep . 1987;;36:3S-15S.
15 +
AIDS Surveillance Update . New York, NY: New York City Dept of Health AIDS Surveillance Unit; December 1987;.
16 +
World Health Organization. International Classification of Diseases, Ninth Revision, Clinical Modification . Geneva, Switzerland: World Health Organization; 1991;.
17 +
Greenberg AE, Thomas PT, Landesman SH, et al.  The spectrum of HIV-related disease among outpatients in New York City. AIDS . 1992;;6:849-859.
18 +
The New York City Department of Health AIDS Surveillance Team.  The AIDS epidemic in New York City, 1981-1984. Am J Epidemiol . 1986;;123: 1013-1025.
19 +
Gertig DM, Marion SA, Schechter MT.  Estimating the extent of underreporting in AIDS surveillance. AIDS . 1991;;5:1157-1164.
20 +
Evans BG.  Estimating underreporting of AIDS: straightforward in theory—difficult in practice. AIDS . 1991;;5:1261-1262.
21 +
United States General Accounting Office. AIDS Forecasting: Undercount of Cases and Lack of Key Data Weaken Existing Estimates . Washington, DC: US General Accounting Office; June 1989;:37-64. GAO/PEMD document 89-13.
22 +
Rauch KJ, Rutherford GW, Echenberg DF.  The proportion of AIDS cases diagnosed in outpatients. JAMA . 1986;;256:863-864.
23 +
Modesitt SK, Smyser M, Hopkins SG, Maden C, Klockner R, Fleming D.  Effects of increasing outpatient diagnosis on AIDS surveillance. J Acquir Immune Defic Syndr . 1993;;6:91-94.
24 +
Carr E, Coppola D, Barry MA. Completeness of outpatient AIDS case reporting—Boston. In: Program and abstracts of the Sixth International Conference on AIDS; June 19-24,1990; San Francisco, Calif. Abstract MC3269.
25 +
Lieb L, Nahlen B, Wakamatsu P. Increasing AIDS case reporting delay in Los Angeles County, 1984-1989. In: Program and abstracts of the Sixth International Conference on AIDS; June 19-24,1990; San Francisco, Calif. Abstract ThC704.
26 +
Centers for Disease Control and Prevention.  1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep . 1992;;41:1-19.

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1 +
AIDS Surveillance Update . New York, NY: New York City Dept of Health Office of AIDS Surveillance; July 1992;.
2 +
HIV/AIDS Surveillance . Atlanta, Ga: Centers for Disease Control; April 1992;.
3 +
United States Congress. S 2240, The Ryan White Comprehensive AIDS Resources Emergency Act of 1990. Congressional Record, House. July 31,1990; H6024-H6048.
4 +
Thomas PA, Weisfuse IB, Greenberg AE, et al.  Trends in the first ten years of AIDS in New York City. Am J Epidemiol . 1993;;137:121-133.
5 +
Greenberg AE, Evans R, Bryan E, Lopez E, Thomas P, and the NYC Expanded Outpatient Surveillance Project. Completeness of AIDS case reporting and the spectrum of HIV-related disease among outpatients in New York City. In: Program and abstracts of the Sixth International Conference on AIDS; June 19-24, 1990; San Francisco, Calif. Abstract ThC708.
6 +
Hindin RH, Thomas P, Nicholas A, Miller N, Schultz S. Evaluating completeness of New York City's case registry. In: Program and abstracts of the Fifth International Conference on AIDS; June 4-9, 1989; Montreal, Quebec. Abstract TAP70.
7 +
Mokotoff ED, Galbraith MA.  Underreporting of AIDS in South Carolina. JAMA . 1990;;263:2449-2450.
8 +
Hardy AM, Starcher ET, Morgan WM, et al.  Review of death certificates to assess completeness of AIDS case reporting. Public Health Rep . 1987;; 102:386-391.
9 +
Buehler JW, Berkelman RL, Stehr-Green JK.  The completeness of AIDS surveillance. J Acquir Immune Defic Syndr . 1992;;5:257-264.
10 +
Conway GA, Coulley-Niemeyer B, Pursley C, et al.  Underreporting of AIDS cases in South Carolina, 1986-1987. JAMA . 1989;;262:2859-2863.
11 +
Rosenblum L, Buehler JW, Morgan MW, et al.  The completeness of AIDS case reporting, 1988: a multisite collaborative surveillance project. Am J Public Health . 1992;;82:1495-1499.
12 +
Calzara LM, Coates RA, Craib KJP, et al.  Underreporting of AIDS cases in Canada: a record linkage study. Can Med Assoc J . 1990;;142:36-39.
13 +
Chamberland ME, Allen JR, Monroe JM, et al.  Acquired immunodeficiency syndrome in New York City: evaluation of an active surveillance system. JAMA . 1985;;254:383-387.
14 +
Centers for Disease Control.  Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR Morb Mortal Wkly rep . 1987;;36:3S-15S.
15 +
AIDS Surveillance Update . New York, NY: New York City Dept of Health AIDS Surveillance Unit; December 1987;.
16 +
World Health Organization. International Classification of Diseases, Ninth Revision, Clinical Modification . Geneva, Switzerland: World Health Organization; 1991;.
17 +
Greenberg AE, Thomas PT, Landesman SH, et al.  The spectrum of HIV-related disease among outpatients in New York City. AIDS . 1992;;6:849-859.
18 +
The New York City Department of Health AIDS Surveillance Team.  The AIDS epidemic in New York City, 1981-1984. Am J Epidemiol . 1986;;123: 1013-1025.
19 +
Gertig DM, Marion SA, Schechter MT.  Estimating the extent of underreporting in AIDS surveillance. AIDS . 1991;;5:1157-1164.
20 +
Evans BG.  Estimating underreporting of AIDS: straightforward in theory—difficult in practice. AIDS . 1991;;5:1261-1262.
21 +
United States General Accounting Office. AIDS Forecasting: Undercount of Cases and Lack of Key Data Weaken Existing Estimates . Washington, DC: US General Accounting Office; June 1989;:37-64. GAO/PEMD document 89-13.
22 +
Rauch KJ, Rutherford GW, Echenberg DF.  The proportion of AIDS cases diagnosed in outpatients. JAMA . 1986;;256:863-864.
23 +
Modesitt SK, Smyser M, Hopkins SG, Maden C, Klockner R, Fleming D.  Effects of increasing outpatient diagnosis on AIDS surveillance. J Acquir Immune Defic Syndr . 1993;;6:91-94.
24 +
Carr E, Coppola D, Barry MA. Completeness of outpatient AIDS case reporting—Boston. In: Program and abstracts of the Sixth International Conference on AIDS; June 19-24,1990; San Francisco, Calif. Abstract MC3269.
25 +
Lieb L, Nahlen B, Wakamatsu P. Increasing AIDS case reporting delay in Los Angeles County, 1984-1989. In: Program and abstracts of the Sixth International Conference on AIDS; June 19-24,1990; San Francisco, Calif. Abstract ThC704.
26 +
Centers for Disease Control and Prevention.  1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep . 1992;;41:1-19.

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